Healthcare Provider Details

I. General information

NPI: 1164153565
Provider Name (Legal Business Name): UPPERLINE HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5066 N 900 E
MONTGOMERY IN
47558-5790
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 450
NASHVILLE TN
37205-5202
US

V. Phone/Fax

Practice location:
  • Phone: 812-486-3396
  • Fax:
Mailing address:
  • Phone: 407-219-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DAVID VANDIVER THORPE
Title or Position: CEO
Credential:
Phone: 205-807-3009